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2019/08/01 All American Asphalt Certificate of Liability Insurance (4)MMID DIYYYY A " E? CERTIFICATE OF LIABILITY INSURANCE DATE 1�17/2a2a ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Edgewood Partners Insurance Center _c°ME TACT Certificates Department P.O. Box 5003 PHONE FAx 925-244-7700 ANC 925-901-0671 San Ramon, CA 94583 1 E-MAIL_ www.epicbrokers.com CA LICENSE #01329370 INSURED All American Asphalt P.O. Box 2229 Corona CA 92878 INSURERS AFFORDING COVERAGE NAIC # _ 21199 INSURERA: Arch Specialty Insurance Company INSURER B: Zurich American Insurance Company 16535 INSURERC: American Guarantee and LiabilitV Ins Co 26247 1NSURERD.: INSURER E : INSURER F : CGVFRAGFS CFRTIFICATF NIIMRFR• szrsz?rra RFVISI(_)N NIIMRFR. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SU13R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER DD/YX YY LIMITS A ✓ COMMERCIAL GENERAL LIABILITY DPC1005856-03 8/1/2019 8/1/2020 EACH OCCURRENCE $1000000 DAMAGE TO RE CLAIMS -MADE OCCUR PREMIS S JEa nccur ence $ 100 000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1 000 o00 GEN'LAGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $2,000,000 POLICY M jpa LOC $ 2 OOO 000 PRODUCTS - COMP/OP AGG $ OTHER: B AUTOMOBILE LIABILITY BAP5571088-07 8/1/2019 8/1/2020 COM131 N ED 5 INGLE LIMIT $ 000 000. BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS $ PROPERTY DAMAGE Po P.6 dent $ HIRED NON -OWNED ✓ AUTOS ONLY ✓ AUTOS ONLY C UMBRELLA LIAB ,/ OCCUR SXS019797003 8/1/2019 8/1/2020 EACH OCCURRENCE $ 5 000 000 AGGREGATE $ 5J)00.000 EXCESS LIAB CLAIMS -MADE DIED I ✓ I RETENTION$10,000 Following -Form $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? NIA IWC593205706 8/1/2019 8/1/2020 ✓ SEAT TE TN $ 1 000 000 E.L EACH ACCIDENT (Mandatory in NH) E.L DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION DF OPERAT)ONSbelow E.L. DISEASE - POLICY LIMIT 1 $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CIP 20-10 Andalusia/Belcanto Asphalt Overlay Project / Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cltxy of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29844 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS. Menifee CA 92586 AUTHORIZED REPRESENTATIVE Certificates Department ~f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 53682659119 [01 ] Standard wi lh $5mm XS 1 Mari to Orridn 1 1 /17/2020 4:33:23 PM (PST) 1 Page I of 1 I EjP_j_1_jC_i PO Box 5003 San Ramon, CA 94583 Phone: 925.244.7700 Fax: 925.901-0244 Email: EPICcerts@epicbrokers.com CERTIFICATE HOLDER: City of Menifee 29844 Haun Road Menifee CA 92586 To: Whom it may concern Regarding: Notice of Cancellation Date Issued: 1/17/2020 Named Insured(s): All American Asphalt Policy Number(s): DPC1005856-03 BAP5571088-07 WC593205706 SXS019797003 Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the above referenced Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, Dan Ryan, Managing Principal epicbrokers.com edgewood partners insurance center ca license OB29370 53682659119 [01] Standard with $5mm XS I Mantra Omelm 1 1/17/2020 4:33:23 PM (PST) I Page 2 of I I COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Any person or organization where the Named Any location where required by written contract or Insured has agreed to add as an additional insured agreement, provided the contract or agreement is by written contract or agreement, provided the executed prior to any 'occurrence" or offense. contract or agreement is executed prior to any "occurrence" or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be CG20100413 broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in © Insurance Services Office, Inc., 2012 Page 1 of 2 53682659 119 [01] Standard with $5mm XS I Marius Omelas 1 1/17/2020 4:33:23 PM (PST) I Page 3 of I I performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: All other terms and conditions of this policy remain unchanged. 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DPC1005856-03 Named Insured: All American Asphalt Endorsement Effective Date: o8/o1/2o1g REFERENCE: CIP 20-10 Andalusia/Belcanto Asphalt Overlay Project / CG20100413 SCHEDULE: City of Menifee, its officers, agents and employees / © Insurance Services Office, Inc., 2012 Page 2 of 2 53682659 119 [01] Standard with $5mm XS I Maritza Omelas 11117/2020 4:33:23 PM (PST) I Page 4 of 11 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization where the Named Insured All locations where required by contract. has agreed to add as an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any 'occurrence" or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such CG 20 37 04 13 additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 2 53682659 119 [oil Standard with $5mm XS I Maritza Omelas 1 1/17/2020 4:33:23 PM (PST) I Page 5 of I I All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DPC1005856-03 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2019 REFERENCE: CIP 20-10 Andalusia/Belcanto Asphalt Overlay Project / CG 20 37 04 13 SCHEDULE: City of Menifee, its officers, agents and employees / © Insurance Services Office, Inc., 2012 Page 2 of 2 53682659 119 [01] Standard with $5mm XS I Maritza Omela 1 1/17/2020 4:33:23 PM (PST) I Page 6 of I I COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: All other terms and conditions of this policy remain unchanged. REFERENCE: CIP 20-10 Andalusia/Belcanto Asphalt Overlay Project / Endorsement Number: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. SCHEDULE: City of Menifee, its officers, agents and employees / This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DPC1005856-03 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2019 CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 536826591 19 [01 ] Standard with $5mm XS I Maritza Omelas 1 1/17/2020 4:33:23 PM (PST) I Page 7 of I I COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization where the waiver of our right to recover is permitted by law and is required by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer for injury or damage arising out of your ongoing Of Rights Of Recovery Against Others To Us operations or "your work" done under a contract of Section IV —Conditions: with that person or organization and included in the "products -completed operations We waive any right of recovery we may have hazard". This waiver applies only to the person against the person or organization shown in the or organization shown in the Schedule above. Schedule above because of payments we make All other terms and conditions of this policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DPC1005856-03 Named Insured:All American Asphalt Endorsement Effective Date: 08/01/2019 REFERENCE. CIP 20-10 Andalusia/Belcanto Asphalt Overlay Project / CG 24 04 05 09 SCHEDULE: City of Menifee, its officers, agents and employees / © Insurance Services Office, Inc., 2008 Page 1 of 1 53682659 119 [01] Standard with $5mm XS I Maritz Omela 1 1/17/2020 4:33:23 PM (PST) I Page 8 of I I 1 /17/2020 POLICY NUMBER: BAP5571088-07 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form This endorsement does not alter coverage provided in tho Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: All American Asphalt Endorsement Effective Date:08/01/2019 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information re aired to complete this Schedule, if not shown above. will bC shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 SCHEDULE: City of Menifee, its officers, agents and employees / © Insurance Services Office, Inc., 2011 Page 1 of 1 53682659 119 [01 ] Standard with $5mm XS I Marit- Omelas 1 1/17/2020 4:33:23 PM (PST) I Page 9 of I 1 1 /17/2020 POLICY NUMBER: BAP5571088-07 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: All American asphalt Endorsement Effective Date: 08/01/2019 SCHEDULE Name(s) Of Person(s) Or Organ ization(s): ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY Information required to complete this Schedule. if not shown above, will be shown in the Declarations. J The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the SCHEDULE: person(s) or organization(s) shown in the Schedule, City of Menifee, its officers, agents and employees / but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 4410 13 C Insurance Services Office, Inc., 2011 Page 1 of 1 53682659 1 19 [01) Standard with $5mm XS i Maritn Omelm 1 1/17/2020 4:33:23 PM (PST) i Page 10 of I I WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.00 % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION SCHEDULE: City of Menifee, its officers, agents and employees / Policy Number: WC593205706 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2019 WC 252 (4-84) WC 04 03 06 (Ed. 4-84) Job Description ALL CALIFORNIA OPERATIONS REFERENCE: CIP 20-10 Andalusia/Belcanto Asphalt Overlay Project Page 1 of 1 536826591 19 [oil Standard with $5mm XS I Maritz 0me1w 1 1/17/2020 4:33:23 PM (PST) I Page I I of I